CAJ | 학술논문

目的探讨食管胃颈部吻合术后颈部吻合口瘘导致脓胸的发生特点及处理对策.方法对2006年1月至2013年1月间河南省安阳肿瘤医院胸外科施行食管癌切除颈部吻合术患者的临床资料进行回顾性分析.结果全组共计3342例食管癌患者行食管胃颈部吻合术,其中左颈左胸二切口2248例(左颈左胸术组),右胸三切口1094例(右胸术组).术后共计发生颈部吻合口瘘237例(7.1％,237/3342),左颈左胸术组152例(6.8％),右胸术组85例(7.8％),差异无统计学意义(P=0.287).19例患者引致脓胸(8.0％,19/237),左颈左胸术组3例(2.0％),右胸术组16例(18.8％),差异有统计学意义(P＜0.01).脓胸发生在3d以内者14例(73.7％,14/19).19例脓胸患者均采用保守治疗,包括行胸腔闭式引流,经鼻腔放置十二指肠营养管或通过空肠造瘘管予以肠内营养支持治疗,并辅以肠外营养支持及抗炎对症治疗.最终治愈16例,死亡3例.结论右侧开胸手术后发生颈部吻合口瘘易导致脓胸.充分引流及良好的营养支持是治疗的重点.
목적 탐토식관위경부문합술후경부문합구루도치농흉적발생특점급처리대책.방법 대2006년1월지2013년1월간하남성안양종류의원흉외과시행식관암절제경부문합술환자적림상자료진행회고성분석.결과 전조공계3342례식관암환자행식관위경부문합술,기중좌경좌흉이절구2248례(좌경좌흉술조),우흉삼절구1094례(우흉술조).술후공계발생경부문합구루237례(7.1％,237/3342),좌경좌흉술조152례(6.8％),우흉술조85례(7.8％),차이무통계학의의(P=0.287).19례환자인치농흉(8.0％,19/237),좌경좌흉술조3례(2.0％),우흉술조16례(18.8％),차이유통계학의의(P＜0.01).농흉발생재3d이내자14례(73.7％,14/19).19례농흉환자균채용보수치료,포괄행흉강폐식인류,경비강방치십이지장영양관혹통과공장조루관여이장내영양지지치료,병보이장외영양지지급항염대증치료.최종치유16례,사망3례.결론 우측개흉수술후발생경부문합구루역도치농흉.충분인류급량호적영양지지시치료적중점.
Objective To investigate the clinical characteristics and managements of pyothorax due to postoperative cervical anastomotic leakage after esophageal cancer surgery.Methods From January 2006 to January 2013,3342 patients with esophageal carcinoma underwent esophagectomy and cervical esophagogastric anastomosis.Of them,19 patients developed pyothorax following cervical anastomotic leakage and their clinicopathological data were analyzed retrospectively.Results All the patients underwent a cervical anastomosis via a three-incisional approach (right cervicothoracic midabdominal incision,RT group,n=1094) or a two-incisional approach (left cervicothoracic incision,LT group,n=2248).The total number of cervical anastomotic leakage cases was 237,of which 152 cases were in LT group(6.8％),and 85 cases in RT group(7.8％),respectively(P=0.287).The incidence of pyothorax was 2.0％(n=3) in LT group,and 18.8％(n=16) in RT group,respectively (P＜0.01).Fourteen cases develop pyothorax within 3 days after operation.The main symptoms were high fever,dyspnea and chest pain.All the pyothorax patients received conservative treatments,including thoroacic closed drainage,nasogastric tube placement,jejunal stoma,nutritional support,antibiotics and symptomatic treatment.Sixteen cases were cured,while 3 cases were dead.Conclusions The right thoracotomy approach predisposes the cervical anastomotic leakage-associated pyothorax.Sufficient drainage and sufficient nutritional support are critical to the treatment.